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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci �z <br /> APPLICATION FOR LAND USE PERMITS 3 4 P <br /> N 0 <br /> al <br /> CD <br /> Q <br /> OWNER ��/Z TELEPHONE d I n <br /> m <br /> HOME ADD SS <br /> o �^ <br /> EMERGENCY/FIRE NUMBER ROAD NAME .. <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt)/LO_ �^ /-7 P J ,, v <br /> C v(/ o) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn o <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADINGG 0 CAMPING UNIT ❑ SUBDIVISION o. <br /> STRUCTURE/ADDITION USE: ( _ i / ► [��� /� p� y'J 'S". <br /> 0 <br /> (Home/Cabin;Commercial Business; Bed om; Dedk;etc.) in <br /> BUILDING CONTRACTOR: a LZ W <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR ETC. THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 O <br /> 0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 9 SS4 0 <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z -� <br /> CONDITIONS OF PERMIT: P `r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ju <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. d 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER a <br /> SETBACK AREA. <br /> 5. <br /> 6. A � d � <br /> m � 3 o. <br /> 7. Z H 79 4 <br /> p <br /> —N: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i ip <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of (n m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize " ' m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oro ther <br /> on. <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspecti <br /> m <br /> CD : <br /> SIGN HERE d+ <br /> (signature owner or building nt ctor) (date) <br /> ZONING ADMINISTRATOR Q� ! v l ? '• <br /> t�+a++n fnww� <br /> NNf7� NNNN <br /> Ul V1 0 p1 N 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />